Chemotherapy for bladder cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Chemotherapy can be given in different ways.

When the drug is put directly into the area to be treated, it is called local chemotherapy. Intravesical therapy, where the drug is placed into the bladder, is a form of local chemo. It was described in the previous section.

When chemo drugs are given in pill form or by injection into a vein (IV) or muscle (IM), the drugs enter the bloodstream and travel throughout the body. This is called systemic chemotherapy. Systemic chemo can affect cancer cells far away from the main tumor. It can be used in different situations:

• It is sometimes given before surgery to try to shrink a large tumor so that it can be more easily removed. Giving chemo before surgery is known as neoadjuvant therapy.
• Chemo can also be given after surgery (or sometimes after radiation therapy). This is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that remain after other treatments but are too small to be seen. This can lower the chance that the cancer will come back later.
• Sometimes chemotherapy is given with radiation therapy to help the radiation work better.
• Chemotherapy is usually the main treatment for advanced cancers, such as those that have spread to distant parts of the body.

Chemo drugs may be used alone or in combination, depending in part on what they’re being used for. For example, when chemo is given with radiation, the most common drugs used include:

• Cisplatin
• Cisplatin plus fluorouracil (5-FU)
• Mitomycin with 5-FU

When chemo is used without radiation, the combinations used most often for bladder cancer are:

• Gemcitabine and cisplatin
• Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (called M-VAC)
• Carboplatin and either paclitaxel or docetaxel (for patients with poor kidney function)

For some people, the side effects of getting more than one chemo drug might be too much to handle. Using a single drug, such as gemcitabine or cisplatin, may be a good option. Other drugs sometimes used alone for bladder cancer include carboplatin, docetaxel, paclitaxel, doxorubicin, 5-FU, methotrexate, vinblastine, ifosfamide, and pemetrexed.

Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemotherapy cycle typically lasts for a few weeks.

Chemotherapy for bladder cancer can be hard to tolerate, especially for older patients who have other serious medical conditions. Older age itself, however, doesn’t mean that you can’t get chemo. Many older patients can tolerate chemotherapy and be helped by treatment. In the end, the decision to have chemotherapy is up to you and your doctor, and should be based on your health, available social support, and personal and family wishes.

Most bladder cancers are transitional cell (urothelial) cancers, but there are other types as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Chemotherapy for these rare types of bladder cancer may use different drugs than those listed above. Often, they are treated with the same drugs used to treat these types of tumors when they are found elsewhere in the body.

Side effects of chemotherapy

Chemotherapy drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

Side effects of chemo depend on the drugs used, the amount taken, and the length of treatment. Side effects tend to be worse when chemo and radiation are given at the same time.

Common side effects seen with chemo include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Diarrhea
• Increased risk of infection (because of a shortage of white blood cells)
• Bleeding or bruising after minor cuts or injuries (due to a shortage of platelets)
• Fatigue (because of low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Along with the risks above, some chemo drugs can cause other, less common side effects. For example, drugs such as cisplatin, carboplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy. Some of the drugs used in chemotherapy have been linked to cases of leukemia later in life, but this is very rare.

You should report any side effects to your medical team so that they can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

For more information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.